Difference between forensic patients with schizophrenia spectrum disorders in Italy and other European countries: Results of the EU‐VIORMED project

Abstract

Background There has been a substantial change in the law on the provision of secure health services for offender‐patients in Italy, a country currently with the lowest general psychiatry bed availability per head of the population in Europe, raising questions about possible differences in offender‐patient admissions between European countries. Aims In this multicentre case–control study, our aim was to compare the socio‐demographic, clinical and criminological characteristics of a sample of Italian forensic in‐patients with schizophrenia or similar psychosis with patients in a similar diagnostic range in specialist in‐patient services elsewhere in Europe. Methods Secure hospital unit in‐patients with psychosis were recruited across five European countries (Italy, Austria, Germany, Poland and England). Consenting patients were interviewed by researchers and assessed using a multidimensional standardised process. Within country similarities between Austria, Germany, Poland and England were confirmed. Results Overall, 39 Italian participants had had fewer years of education than the 182 patients in the other countries and were less likely to have ever had skilled or professional employment. The Italian patients had been older at first contact with any mental health services than the other Europeans. Diagnosed comorbidity rates were similar, but the Italian group reported higher levels of disability. Although the other European forensic patients were more likely to be undergoing treatment at the time of their index offence, they were also more likely to have been poorly compliant with treatment. The rate of suicide‐related behaviours was significantly lower among the Italian patients than among the others. Conclusions Notwithstanding similar diagnoses, important differences emerged between patients in Italian forensic mental health resident services and those in four other European countries, some possibly reflecting less access to earlier relevant services in Italy. Others, including lower disability ratings among the Italian patients and a lower rate of suicide‐related behaviours, may indicate that the Italian reforms carry benefits. This is worthy of further evaluation.

A comparison of patient ratings and staff ratings of disability using the World Health Organisation Disability Assessment Schedule in individuals with psychotic spectrum disorders who are forensic psychiatric inpatients

“…WHODAS has not been extensively used in individuals with comorbid drug abuse, those incarcerated in prison or in forensic psychiatric care with only one study to date finding low patient disability ratings on the 12-item WHODAS in a forensic psychiatric setting (Castelletti et al, 2023).…”

“…A systematic search of PubMed, Cinahl and Psych Info for the terms 'WHODAS', 'psychosocial function' and 'disability' with 'forensic psychiatry' or 'forensic assessment' yielded several articles examining Global Assessment of Functioning, but only one examining WHODAS scores in an inpatient setting (Castelletti et al, 2023). This situation is despite a review in 2010 calling for measures of psychosocial function to be included as outcome measures for forensic psychiatry programmes (Fitzpatrick et al, 2010).…”